REL Midwest Data Collection Instruments

— 1 

## B

- 1. Draft Protocol

— School

- Level Survey (Treatment Contrast and Data

- Informed Allocation of Dropout Prevention Interventions for Students)



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According to t he Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control
number. The valid OMB control number for this information collection is XXXX

- XXXX

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. This information collection is voluntary. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202

– 4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Christopher Boccanfuso, U.S. Department of E ducation, Institute of Education Sciences, Room 506D, 555 New Jersey Ave. NW, Washington, DC 20208

- 5500.

Per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E, Section 183, responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual. Any willful disclosure of such information for nonstatistical purposes, except as required by law, is a class E felony.



### ** This survey will be administered to both treatment and control schools to estimate the impact
of EWIMS on school

- level outcomes

The purpose of this draft school

- level survey is twofold: the firs t section documents current usage of an early warning system tool or the use of data to identify students who are at risk of academic failure, disengagement, and/or dropping out of high school, and will be used to
measure the treatment contrast in the EWIM S impact study . We will use this information to document the treatment contrast. Measures are adapted from the REL Appalachia survey in an attempt to coordinate data collection across RELs on similar EWS implementation studies.

These second section collect s consistent information from treatment and control schools about the types of dropout interventions they are implementing and whether and how they use student data to allocate those dropout interventions. This section will be used to answer school

- level

r esearch questio n 2a : What is the impact of EWIMS on data

- informed allocation of dropout prevention interventions for students? Items are based on up

- to

- date input from the Dropout
Prevention Research Alliance members ’ input, as well as a collaboration betw een REL Appalachia and REL Midwest to develop similar tools for EWS implementation studies. The study team plans to continue to review and populate these response options prior to
administration and in collaboration with alliance members to reflect the mos t up

- to

- date local.

These items are still in draft form and will be finalized with input from REL Midwest’s Dropout

Prevention Alliance.REL Midwest Data Collection Instruments

— 2



### Section I: Treatment Contrast

— Use of an Early Warning System

1. Is your high school using an early warning system ( EWS ) to identify students who may be at risk of not graduating from high school on time?



# o Yes, we are implementing EWS in my high school

If yes, what is the name of your early warning system ?

________________________.



# o No, my high school is not currently implementing EWS in any high schools (IF NO, SKIP TO QUESTION 5 )

2. Please tell us when you began implementing an early warning system in your school, and the degree of implementation in each school year

.

Time Period Degree of Implementation

Before the 2010

– 11 school year Drop down menu a



### 2010

– 11 school year Drop down menu a



### 2011

– 12 school year Drop down menu a



### 2012

– 13 school year Drop down menu a



### 2013

– 14 school year Drop down menu a



### Other (Please specify) Drop down menu a

a Drop down menu: Beginning stages, In progress, Mastered the tool and

process



### 3. How do you use the early warning system? (Please check all that apply)



# o To identify students at risk based on attendance



# o To identify students at risk based on course failure



# o To identify students at risk based on behavior



# o To target resources to support off

- track students before they drop out



# o To assign students to intervention(s)



# o To monitor student progress or students’ response to intervention(s)



# o To examine patterns and identify school c limate issues



# o Other ( p lease specify)

_____________________________________________________

4. What kinds of reports does your early warning system generate? (Please check all that apply)



# o Student

- level reports that show lists of students and risk statusREL Midwest Data Collection Instruments

— 3



# o School

- level , or graphical, reports that show trends in student risk status across the school
or time



# o Reports (student or school level) for key subgroups (e.g., students with disabilities) of
students



# o Intervention

- level reports that allow us to monitor the effectiveness of our interventions



# o Other ( p lease specify)

____________________ _________________________ ________

~~~~~~~ ~~~~~~~~~~~~~~~ Skip Pattern from Question 1

~~~~~~~~~~~~~~~~~~~~~~~~ ~~~

The following questions ask about how your school uses data to identify students who may

be at risk for not graduating on time

.

5. Do teachers in your school have access to student data that identifies students at risk of not graduating?



# o Yes, and all teachers access it regularly



# o Yes, a nd some teachers access it regularly



# o Yes, and some teachers access it occasionally



# o Yes, but very few teachers actually access it



# o Yes, but no teachers actually access it



# o No, teachers do not have access to this type of data



# o Other (please specify)

___________ __________

6. Does your school review student attendance data to determine which students may be at risk (i.e., missing more than # days per year)?



# o Yes



# o No (IF NO, SKIP TO QUESTION 9)REL Midwest Data Collection Instruments

— 4



### 7. For which grades do you examine student attendance data ? ( Please check all that apply

. )



# o Grade 9



# o Grade 10



# o Grade 11



# o Grade 12

8. How often do you review these data?



# o Daily



# o Weekly



# o Monthly



# o 4 times per year (once per quarter)



# o 3 times per year



# o 2 times per year



# o 1 time per year

9. How often do you use attendance data to assign students to s pecific interventions or support
services?



# o Never



# o Rarely



# o Sometimes



# o Always

10. Tell us a little bit about how you use attendance data in your school :

11. Does your school review student course performance data (including course failures, credit deficiencies) to determine which students may be at risk?



# o Yes



# o No (IF NO, SKIP TO QUESTION 15 )REL Midwest Data Collection Instruments

— 5



### 12. For which grades do you examine course performance data (including cou rse failures, credit deficiencies) ? ( Please check all that apply).



# o Grade 9



# o Grade 10



# o Grade 11



# o Grade 12

13. How often do you review these data?



# o Daily



# o Weekly



# o Monthly



# o 4 times per year (once per quarter)



# o 3 times per year



# o 2 times per year



# o 1 time per year

14. Tell us a little bit about how you use course performance data (including course failures,

credit deficiencies) data in your school:REL Midwest Data Collection Instruments

— 6



### 15. What other kinds of student data do you look at

, and for which grades ? (Please check all that apply

. )

We do

not use We use in these grades

Grade 9 Grade 10 Grade 11 Grade 12

Behavior referrals     

Behavior suspensions     

Grade p oint a verage (GPA)     

State assessment results     

Other:     

Other:     

Other:     

Other:     

The following questions ask about the structure of data review in your high school
, focusing on th e grou p o f individual s wh o use student data to identify students who may be

a t ris k o f no t graduatin g fro m hig h school on time

. Thes e individual s ma y b e par t o f a distinc t early warning system team o r part o f anothe r tea m tha t i s responsibl e fo r examinin g thes e data.

16. Does your school have a team or group of individuals that reviews student data to support students who are identified as at risk of not graduating from high school? (e.g.

, building

- or teacher

- level teams , Student Success Teams, Data Review Teams)



# o Yes, we have a dedicated school

- based team.

If yes, what is the goal or purpose of this team ? ________________

___________

_________________________________________________________________



# o No, we do not have a dedicated school

- based team.



# o Other (please specify)REL Midwest Data Collection Instruments

— 7



### 17. How often does your team meet to review student data?



# o Weekly



# o Monthly



# o 4 times per year (once per quarter)



# o 3 times per year



# o 2 times per year



# o 1 time per year

18. How often does your team meet to assign students at risk to support and/or interventions?



# o Weekly



# o Monthly



# o 4 times per year (once per quarter)



# o 3 times per year



# o 2 times per year



# o 1 time per y ear

19. Describe the members of the team at the high school level (if applicable)

. (Please check all that apply.)



# o School principal



# o Assistant principal



# o Representative from feeder middle schools



# o Guidance counselors



# o Content area teachers



# o Special education teachers



# o English language learner instructors



# o District office representative



# o Community service providers



# o Community members



# o Other (please specify) _____________________________________________________REL Midwest Data Collection Instruments

— 8



### 20. To what extent do you agree with the following statemen t: “Implementing an early warning system will lead to improved graduation rates .”



# o Strongly d isagree



# o Disagree



# o Agree



# o Strongly a gree

21. How often does your school reflect on the process of identifying and assigning students at
risk to interventions ?



# o More than twice a year



# o Twice a year



# o Once a year



# o We do not have this opportunityREL Midwest Data Collection Instruments

— 9



### Section II: Data

- Informed Allocation of Dropout Prevention Interventions for Students

1. Does your school offer targeted academic interventions (e.g., tutoring, reading remediation, study skills) for students?



# o Yes



# o No (IF NO, SKIP TO QUESTION 3 )REL Midwest Data Collection Instruments

— 10



### 2. P lease name the targeted academic interventions that the school offers. In the table below, indicate which programs are availa ble, the number of students who participated during the school year, and the grade level of students who participated.

Program

nam e Focus of the

intervention How is this

program delivered? Who delivers

this program? # of

participating

students Grade

level(s) of

students Who refers

students for this program? What criteria are

used to select
students for participation in targeted acade mic
interventions? What data do you

use to determine

whether an
intervention/ support is working?

Write in Drop down

menu (reading, mathematics, science, tutoring, remediation, study skills, other please specify) Drop down

menu (individually to students, via small group, via large

group, schoolwide, other please specify) Drop down

menu (teachers, administrators, guidance department, community members,
parents, peers [ other students ]

, other please specify) Drop down

menu

(from 1 to 999) Drop down

menu (from grade 9 to grade 12) Drop down menu

allowing checking all that apply (administrator, counselor, parent, teacher, data team, student, [self], other please specify) Drop down menu

allowing checking all that apply (course failure [e.g., failing

A lgebra] , grade point average [GPA], number of credits, student attendance [e.g., missing a number of days of school or class], student behavior [e.g., office referrals, suspensions], no criteria, other please specify) Drop down menu allowing checking all that app ly (attendance, behavior, course performance, core course performance, GPA, credits earned, behavior referrals, behavior suspensions, no criteria, other please specify)REL Midwest Data Collection Instruments

— 11



### 3. Does your school offer targeted behavior interventions (e.g., social skill training, character education) for students?



# o Yes



# o No ( IF NO, SKIP TO QUESTION 4 )

a. Please name the targeted behavior interventions at the school. In the table below, indicate which programs are available, the number of students who participated during the school year, and the grade level of students who participated.

Program

name Focus of the

intervention How is this

program delivered? Who delivers

this program? # of

participating

s tudents Grade

level(s) of

students Who refers

students for this program? What criteria are used

to select students for participation in targeted behavior
inte rventions? What data do you

use to determine

whether an
intervention/ support is working?

Write in Drop down

menu (social skill training,
character education, other please specify) Drop down

menu (individually to students,
via small group, via large group, schoolwide, other please specify) Drop down

menu (teachers, administrators, guidance department, community members,
parents, peers [other students]

, other please specify) Drop down

menu

(from 1 to 999) Drop down

menu (from grade 9 to grade 12) Drop down menu

allowing checking all that apply (administrator, counselor, parent, teacher, data team, student, [self], other please specify) Drop down menu

allowing checking all that apply (course failure [e.g., failing A lgebra], grade point average [GPA],

nu mber of credits, student attendance [e.g., missing a number of days of school or class], student behavior [e.g., office referrals, suspensions], no criteria, other please specify) Drop down menu allowing checking all that apply (attendance, behavior, cours e performance, core course performance, GPA, credits earned, behavior referrals, behavior suspensions, no criteria, other please specify)REL Midwest Data Collection Instruments

— 12



### 4. Does your school offer targeted attendance/truancy interventions (e.g., attendance monitor) for students?



# o Yes



# o No ( IF NO, SKIP TO QUESTION 5 )

a. Please name the targeted attendance/truancy interventions that the school offers. In the table below, indicate which programs are available, the number of students who participated during the school year, and the grade level of students who participated.

Program

name Focus of the

intervention How is this

program delivered? Who delivers

this program? # of

participating

students Grade

level(s) of

students Who refers

stude nts for this program? What criteria are

used to select
students for participation in targeted behavior
interventions? What data do you

use to determine

whether an
intervention/ support is working?

Write in Drop do wn

menu (attendance monitoring, contacting
truancy officers,
automated
contact with families,
conferences
with families and students, other please specify) Drop down

menu (individually to students, via small group, via large

group, schoolwide, other please specify) Drop down

menu (teachers, administrators, guidance department, community members,
parents, peers [other students]

, other please specify) Drop down

menu

(from 1 to 999) Drop down

menu (from grade 9 to grade 12) Drop down menu

allowing checking all that apply (administrator, counselor, parent, teacher, data team, student, [self], other please specify) Drop down menu

allowing checking all that apply (course failure [e.g., failing A lgebra], grade point average [GPA], number of credits, student attendance [e .g., missing a number of days of school or class], student behavior [e.g., office referrals, suspensions], no criteria, other please specify) Drop down menu allowing checking all that apply (attendance, behavior, course performance, core course performance

, GPA, credits earned, behavior referrals,
behavior suspensions, no criteria, other please specify)REL Midwest Data Collection Instruments

— 13



### 5. Does your school offer credit or content recovery (e.g., online programs such as Apex, K12, Plato, or another district program)?



# o Yes



# o No 

### (IF NO, SKIP TO QUESTION 6 )

a. Please name the credit recovery programs that your school offers. In the table below, indicate which programs are available, the number of student who participated during the school year, an d the grade level of students who participated.

Program

name Focus of the

intervention How is this

program delivered? Who

delivers this program? # of

participating

students Grade

level(s)
of

students Who refers

students for
this program? What criteria are used to

select students for participation in targeted
behavior interventions? What data do you
use to determine

whether an intervention/ support is working?

Write in Drop down

menu (reading, mathematics, science, tutoring, remediation, study skills,
other please specify) Drop down

menu (individually to students,
via small group, via large group, schoolwide, other please specify) Drop down

menu (teachers, administrators, guidance department, community members,
parents, peers [other students] , other please s pecify) Drop down

menu

(from 1 to 999) Drop

down

menu (from grade 9 to grade 12) Drop down

menu allowing checking all that apply (administrator, counselor, parent, teacher, data team, student, [self], other please specify) Drop down menu allowing

checking all that apply (course failure [e.g., failing A lgebra], grade point average [GPA], number of credits, student attendance [e.g., missing a number of days of school or class], student behavior [e.g., office referrals, suspens ions], no criteria, other please specify) Drop down menu allowing checking all that apply (attendance, behavior, course performance, core course performance, GPA, credits earned, behavior referrals, behavior suspensions, no criteria, other please specify)REL Midwest Data Collection Instruments

— 14



### 6. Does your school offer student mentoring programs (e.g., Check & Connect, Check In/Check Out)?



# o Yes



# o No 

### (IF NO, SKIP TO QUESTION 7 )

a. Which of the following mentoring programs does the school offer or do students have access to in the community? In the table below, indicate which programs are available, the number of students who participated during the school year, and the grade
level o f students who participated.

Program

name Focus of the

intervention How is this

program delivered? Who delivers

this program? # of

participating

students Grade

level(s) of

students Who refers

students for this program? What criteria are used

to select stu dents for participation in targeted behavior
interventions? What data do you

use to determine

whether an
intervention/ support is working?

Write in Drop down menu

(academic mentoring, school adjustment mentoring [e.g., 9th grade transition program, reentry from adjudication], career mentoring, project

- based and community

- based mentoring, group

- specific mentoring, peer mentoring, other please specify) Drop down

menu (individually to students,
via small group, via large group, schoolwide, other please specify) Drop down

menu (teachers, administrators, guidance department, community members,
parents, peers [other students]

, other please specify) Drop down

menu

(from 1 to 999) Drop down

menu (from grade 9 to grade 12) Drop down menu

allowing checking all that apply (administrator, counselor, parent, teacher, data team, student, [self], other please specify) Drop down menu allowing

checking all that apply (course failure [e.g., failing

A lgebra], grade point average [GPA], number of credits, student attendance [e.g., missing a number of days of school or class], student behavior [e.g., office referrals, suspensions], no criteria, other please specify) Drop down menu allowing checking all that apply (attendance, behavior, course performance, core

cours e performance, GPA, credits earned, behavior referrals, behavior suspensions, no criteria, other please specify)

Check &
Connect

Check In
Check Out

Gear UpREL Midwest Data Collection Instruments

— 15



### 7. Does your school offer a student internship or school

- related work

- preparation program (such as Job Corp, MACC Project, or career and technical education classes or programs)?



# o Yes



# o No (IF NO, SKIP TO QUESTION 8 )

a. Which of the following student internship or school

- related work

- preparation programs does the school offer? In the table below, indicate which programs are available, number of student who participated during the school year, and the grade level
of studen ts who participated.

Program name Focus of the

intervention How is this

program delivered? Who delivers

this program? # of

participating

students Grade

level(s) of

students Who refers

students for this program? What criteria are used to

select students fo r participation in targeted
behavior interventions? What data do you
use to determine

whether an
intervention/ support is working?

Write in Drop down

menu (internship,
work

- prep, other please specify) Drop down

menu (individually to students,
via small group, via large group, schoolwide, other please specify) Drop down

menu (teachers, administrators, guidance department, community members,
parents, peers [other students]

, other please specify) Drop down

menu (from 1 to 999) Drop down

menu (from grade 9 to grade 12) Drop down menu

allowing checking all that apply (administrator, counselor, parent, teacher, data team, student, [self], other please specify) Drop down menu allowing

checking all that apply (course failure [e.g., failing A lgebra], grade point average [GPA], number of credits, student attendance [e.g., missing a number of days of school or class], student behavior [e.g., office referrals, suspensions], no criteria, other please specify) Drop down menu allowing checking all that apply (attendance

, behavior, course performance, core course performance, GPA, credits earned, behavior referrals, behavior suspensions, no criteria, other please specify)
Job Corps
AmeriCorps

Post

- Secondary Enrollment Options program at Kent State University

Career and technical education program(s) (e.g., culinary arts)

Career and technical education class(es) that are not part of a program

Other

— please describe:REL Midwest Data Collection Instruments

— 16



### 8. Does your school offer student college preparation programs (such as AVID or Gear Up)?



# o Yes



# o No (IF NO, SKIP TO QUESTION 9 )

a. Which of the following college preparation programs does the school offer? In the table below, indicate which programs are available, the number of students who participated during the school year, and the grade level of students who participated.

Program

name Focus of the

intervention How is this

program delivered? Who delivers

this program? # of

participating

students Grade

level(s) of

students Who refers

students for this program? What criteria are used

to select students for participation in targeted b ehavior
interventions? What data do you

use to determine

whether an
intervention/ support is working?

Write in Drop down menu (general

college prep, financial aid assistance, application process assistance, support for college entrance exams, academics, other please specify) Drop down

menu (individually to students,
via small group, via large group, schoolwide, other please specify) Drop down

menu (teachers, administrators, guidance department, community members,
parents, peers [other students]

, other ple ase specify) Drop down

menu

(from 1 to 999) Drop down

menu (from grade 9 to grade 12) Drop down menu

allowing checking all that apply (administrator, counselor, parent, teacher, data team, student, [self], other please specify) Drop down menu allowing

checking all that apply (course failure [e.g., failing

A lgebra], grade point average [GPA], number of credits, student attendance [e.g., missing a number of days of school or class], student behavior [e.g., office referrals, suspens ions], no criteria, other please specify) Drop down menu allowing checking all that apply (attendance, behavior, course performance, core course performance, GPA, credits earned, behavior referrals, behavior suspensions, no criteria, other please specify)

Early College High School

AVID

Gear Up

Talent DevelopmentREL Midwest Data Collection Instruments

— 17



### 9. In what other ways do you assign students to intervention, or support programming?



# o Demographics (such as free or reduced

- price lunch)



# o We use teacher recommendations or referrals



# o Other types of data (please specify)